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The business of hygiene
The title of this article inevitably bothers some hygienists. After all, hygiene school does not teach anything about the ‘business’ of hygiene, so many hygienists feel running a hygiene department as a business is wrong and impinges on the quality of care.
Dental hygiene curricula is focused on educating students to be safe clinicians upon graduation. This rigorous schedule does not allow for time to be spent on non-clinical education. What is taught in school is what clinicians feel is right. While schools need to focus on patient care in order to produce clinicians, the lack of education regarding the business side of hygiene makes it difficult for hygienists to understand that dental hygiene is a business.

Yet, in reality, dental hygiene is a business within a business. The hygiene department is responsible for bringing in enough money to pay for all the expenses incurred by the department, cover hygiene salaries and benefits, and make a profit. Industry standards state that 33 per cent of total practice production should come from the hygiene department, and that hygiene wages and benefits should never exceed 33 per cent of hygiene production. The last industry standard suggests that 33 per cent of hygiene production should come from periodontal codes.

If these standards are met, the hygiene department should operate as a profitable business. If these standards are not met, the dentist needs to subsidize the hygiene department with his/her production. Hygienists need to be aware of their percentages. If stats are not at the level they should be, the hygienist needs to take measures to help improve them.

Recall system

Quite frequently, hygiene numbers that are below the industry standard are that way because of an inefficient recall system. One of the biggest problems an inefficient recall system causes is openings in the schedule. A chair that is sitting empty is not bringing revenue in. Even worse is that an empty chair is actually causing the department to lose existing money if the hygienist is paid while the chair is vacant. An evaluation of this system can be undertaken by answering the following questions:

• Does the office have a staff member whose job description includes responsibility for the recall system?

• Is the hygiene schedule full (less than 30 minutes open per hygienist per day)?

• Is the amount of production lost due to open time being monitored?

• How does the office determine the amount of hygiene hours needed each month to accommodate all the patients in need of a professional cleaning and oral examination?

• Is the available hygiene time based upon the number of active recall patients in the practice?

• Is the amount of hygiene hours needed determined every three months?

A “no” response to two or more of these questions points to a potentially inefficient recall system. Without fixing this system, the hygiene department will struggle to meet industry standards, and probably will always need subsidizing from the dentist’s production.

Periodontal protocol system

Another deficiency that leads to not meeting industry standards is the lack of a sound periodontal protocol system. Without a system in place, hygiene departments are prophy driven. Fees collected primarily from prophys will not sustain a hygiene department. In today’s dental climate, no hygiene department should be prophy based.

Research shows at least 33 per cent of the adult population has some form of periodontal disease. It would make sense then that at least 33 per cent of adult patients, in any given practice, should be in a periodontal program. Having patients who require periodontal services receiving necessary treatment is a win for the patient and a win for the hygiene department. Perio services are charged out at a higher rate and, therefore, can help sustain hygiene.

If a periodontal protocol does not exist, patients are not being examined thoroughly for the presence of periodontal disease. The most important element in detecting periodontal disease is completion of a periodontal probing and charting. Current standard of care requires that patients receive six-point periodontal probing and charting on an annual basis at minimum. While this is the standard of care, the American Academy of Periodontology has stated that 73 per cent of dental offices do not diagnose periodontal disease. According to the American Dental Association, 50 per cent of the offices diagnosing periodontal disease do not probe on a regular basis. This means, at best, 13.5 per cent of dental offices across the country are meeting the periodontal probing standard of care.

Implementation of a periodontal protocol that mandates annual probing/charting of all adult patients is the first step toward delivering the current periodontal standard of care and increasing hygiene revenue. Protocol also needs to dictate treatment needs to be delivered based upon probing/charting data.

Review of an existing recall system can typically be completed by dental practice management consultants. Information can also be found on dental practice management Web sites. Periodontal protocols can be found in textbooks, Web sites and in conjunction with many periodontal related products. Knowledge of what a successful recall system is and what an effective periodontal protocol is, followed by implementation of both systems, will certainly lead to an improvement in the business of hygiene.

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